Cory Coleman
Individual provider Active NPI Adult Care Home Facility · Sanderson, FL
NPI 1306656624 · NPPES record last updated Jan 9, 2025
Key facts
- NPI
- 1306656624
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Care Home Facility 311ZA0620X
- License
- 6907127 (FL)
- Practice address
- 14164 US Highway 90
Sanderson, FL 32087-2356 - Phone
- (904) 535-9302
- Fax
- (904) 397-2699
- NPI assigned
- Jan 9, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6907127 | FL | MD | Adult Care Home Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oretga Adult Living, LLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 6907127 | FL | Yes |
Addresses
Primary practice location
14164 US Highway 90
Sanderson, FL 32087-2356
Mailing address
14164 US Highway 90
Sanderson, FL 32087-2356
Phone (904) 535-9302
Other providers in Sanderson, FL
- Barbara Cox
- Tequela Yashan Donaldson
- Gifted Touch LLC
- Rayandral N Givens
- Givens' Home Care and Essential Staffing
All providers in Sanderson, FL · Adult Care Home Facility in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.